Smoking Cessation Treatment Delivery to Cervical Cancer Survivors with Low Social Resources: A Pilot RCT

A seminal report of the NCI Center to Reduce Cancer Health Disparities (Freeman & Wingrove, 2005) postulates that a high rate of cervical cancer is a marker of more entrenched problems with socioeconomic disadvantage and healthcare access. A close look at U.S. cervical cancer rates shows clear disparities with greater burden among women who are poor and/or live in Appalachian and rural areas. The same disparity exists in U.S. smoking rates, such that prevalence is highest among individuals who have low socioeconomic status and/or Appalachian and rural residence. The fact that cervical cancer and smoking share the same social risk factors might explain, at least in part, why cervical cancer survivors continue to smoke at such a high rate (40-50%) despite the link between smoking and poor cancer outcomes. Without question, there is need for smoking cessation treatments that are sensitive to the social challenges many cervical cancer survivors face on a daily basis (e.g., low income, high unemployment, low literacy, poor healthcare access, low availability of formal social support resources). The current study will test the feasibility, acceptability, and efficacy of a smoking cessation treatment designed to engage cervical cancer survivors into the process of quitting and empower them to use local and national resources that can help address unmet social support needs. This pilot randomized clinical trial will include 60 cervical cancer survivors from Appalachian and rural counties in Kentucky recruited via population- and clinic-based channels. Participants will be followed for 45 days and smoking cessation outcomes include motivation/confidence to quit, quit attempts, and short-term abstinence. Treatment involves brief advice to quit plus delivery of a free 2-week supply of nicotine replacement therapy (NRT) and a social resource referral kit that serves as a directory for free or low-cost services that can help address key social factors that might otherwise undermine quit success. Treatment is admittedly minimal, but that is precisely why it has potential for great population impact–it lends itself to the real world where any healthcare provider can easily disseminate NRT samples and social resource referral kits to cervical cancer survivors who smoke. Consistent with public health efforts to increase evidence-based treatment (in this case, NRT) access to under-resourced and under-served populations, this intervention is designed to address the critically important and clinically significant problem of smoking after cervical cancer.